Type 2 Diabetes, a Dietary Disease #373: The “blame the patient” game

Let me be clear. I don’t really think your primary care doctor, who is perhaps an internist/cardiologist (like mine) or maybe a family care doctor, is being disingenuous when he or she writes in your file, “patient non-compliant.” They almost certainly, or for the most part, sincerely believe in the advice they have given you. They advised you how to lose weight (exercise a lot and eat a calorie-restricted balanced diet), specifically to eat a “healthy low-fat diet,” And when you failed to get the results they expected, they concluded it was because you didn’t follow their counsel. So, they deduce, you must have cheated. You were “non-compliant.”

Why do they expect this result, you ask? Because the Guidelines for Clinical Practice for each of the practice specialties, and the governing medical associations (the AMA, AHA, ADA, etc.), all told them to. That is the result of virtually all of the patient cohorts who were given this advice before you. So, the explanation – the reason – must be that it was the patient who failed to follow it…who was non-compliant. That’s also when the clinical guidelines tell them to start you on drugs to accomplish what you failed to do.

It never occurs to them that it could be the advice they gave you that failed to produce the outcome they (and you) desired. The advice to eat a low saturated fat, low cholesterol diet has now been in place for over half a century – since the time any doctor in practice today went to medical school. The advice was first popularized by the publicity given to the treatment of Eisenhower after his first heart attack in 1955. Before he died 14 years later, he was to have 7 myocardial infarctions, 14 cardiac arrests, and at least 1 stroke, but never mind….

The advice to eat a low saturated fat, low cholesterol diet was also strongly espoused by a University of Wisconsin physiologist, Ancel Keys. The bad science, publicized in his “Six Country Analysis” (1955), and later compounded in his “Seven Countries Study” (1958), has since been widely discredited, but never mind….

By January 1961, Keys was on the cover of then popular Time magazine and had been invited to join the Board of The American Heart Association. And to this day the AMA still espouses a low saturated fat, low cholesterol diet. The evidence that this advice is faulty – in fact, is the virtual opposite of the heart-healthy diet that you should be eating – has existed from “the beginning.” See this timeline, by Diet Heart Publishing.

The evidence supporting a healthy diet has now been well documented in the last decade in at least three thoroughly researched, landmark books: 1) Gary Taubes’s “Good-Calories, Bad-Calories”; Denise Minger’s, “The Big Fat Surprise”; and Gary Taubes’s new, “The Case Against Sugar.” There are many others, but these three are the best. They’re an easier read than the peer-reviewed scientific journals they’re based upon.

What got me going on this minor rant was this article in Medscape Medical News last month that described the efforts of scientists to “reprogram” alpha cells in the pancreas to regenerate new beta cells in mice. These are the cells that make insulin until they are destroyed by an autoimmune disorder, as in type 1 diabetes, or they just wear out from overuse due to Insulin Resistance in type 2 diabetes.

What set me off in this article was the suggestion that a similar advance (an “artificial pancreas”) “may enable tight glycemic control with minimal patient intervention” (my emphasis). Great news for type 1s, of course, but from my perspective (as a type 2) it just reinforces the notion that “minimal patient intervention” was the only course of treatment available for type 2s in the clinical setting since patients are “non-compliant” and fail to achieve the desired outcomes when they follow their doctor’s advice. THUS, THE PATIENT IS TO BLAME!

But what if you, the patient, took control of your diet and your metabolic health, and ate a healthy, low carb, moderate protein, high fat diet, including heart healthy saturated fat, without concern for dietary cholesterol? What if you did this and the outcome was a big weight loss and a lab report with an improved lipid panel?

 Or you could just follow the dietary advice given to President Eisenhower in 1955. Remember that outcome?